gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

The incidence and survival of patients with cerebral metastases of newly diagnosed lung cancer – A retrospective correlative analysis

Meeting Abstract

  • Peter Emich - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz
  • Thomas Wehler - Klinik und Poliklinik für Hämatoonkologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz
  • Ömer Senbaklavaci - Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz
  • Alf Giese - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz
  • Angelika Gutenberg - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.06.03

doi: 10.3205/13dgnc208, urn:nbn:de:0183-13dgnc2082

Published: May 21, 2013

© 2013 Emich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The historically poor prognosis of patients with brain metastases (BM) results in their exclusion from many clinical trials. Unfortunately, this trend persists despite improvements in CNS (central nervous system) control and in overall survival of patients with BM.

Method: This is a retrospective single-institutional analysis between 01.01.2008 and 31.12.2010. Overall and post-BM survival were correlated to therapy modalities applying pre- and post-BM. Univariate associations were analyzed using Kaplan-Meier survival analysis, and the effect of independent predictors were assessed using a multivariate Cox proportional hazards regression.

Results: A total of 430 patients with newly diagnosed lung cancer over the given three years period were studied. Male patients made up 66% of the population. The most common histologic type was adenocarcinoma (ADC) (41%), followed by squamous cell carcinoma (SQC) (21%) and small cell carcinoma (SCLC) (12,4%). Of the total number of patients, 120 (28%) developed BM within a mean follow-up time of 8.9 months (3–48 months). BM were most often found in patients with ADC (55%) and SCLC (25%). In 43,6%, BM led to the diagnosis of primary lung cancer, in 27,3%, BM were synchronously diagnosed (within 3 months), and in 29,1% BM developed within 4 years after the primary tumor diagnosis. Overall survival was 18.4 months, BM significantly reduced survival probability (10.6 months versus 23.6 months with or without BM, p=0.00009). Different treatment modalities for BM significantly influenced post-BM survival (p=0.0003): best supportive care was initialized in 9 patients (0.8 months post-BM survival), 71 received WBRT (whole brain radiotherapy) (7.8 months), BM were neurosurgically resected followed by WBRT in 32 (17.8 months), neurosurgical resection was followed by SRS (stereotactic radiosurgery) in 3 (23.15 months), 3 had neurosurgical resection only (2.0 months) and 1 patient each received SRS alone or followed by WBRT.

Conclusions: Our institutional incidence of BM in lung cancer is as high as 28%, with up to 55% in patients with ADC. The outcome in patients with BM is heterogeneous, but in selected patients a tailored therapy with neurosurgical resection followed by WBRT or SRS leads to equally good survival times as in those patients without BM. Clinical trials, especially for NSLC (non-small lung cancer), therefore need to include patients with BM, not only to be more representative of the majority of patients, but to extract those patients with BM, who will benefit from newer therapeutic strategies.